Oxytocin, ergonovine, and methylergonovine are used in the normal third stage of labor (Cunningham et al., 2013b). After vaginal deliveries, the oxytocin is administered intramuscularly immediately after delivery of the fetus. Oxytocin, 20 units added to 1L of intravenous solution, is typically administered after delivery of the placenta and continued in post-anesthesia phase. Patients with intravenous access may have an infusion which
should be carefully monitored to avoid tetanic uterine contractions and increased pain. Ergot alkaloids are powerful myometrial stimulants resulting in contraction that may persist for hours. These agents can precipitate severe hypertension. Prostaglandins are another option for bleeding during third stage labor. Hemabate (carboprost 250 mcg and tromethamine 83 mcg/1 mL) is one such drug that may be used for the treatment of refractory postpartum uterine bleeding. It is given as a deep intermuscular injection and may be repeated. Buccal or rectal misoprostol (Cytotec) may also be administered.